Strength and Limitations:
One major strength of our study is the strict use of inclusion criteria.
Only patients matching all Mississippi or Tennessee criteria for HELLP
syndrome were included in our study. Additionally, AFLP was only
diagnosed when at least six Swansea criteria out of 15 were present. A
limitation is the relatively small sample size of cases with AFLP.
However, considering the rarity of the disease and the striking
difference in particular of sFlt-1 between the groups we are confident
that our findings together with the observation by Suzuki et al and
Neuman et al. may elucidate that pregnancies compromised by AFLP show a
different angiogenic pattern compared with other liver-associated
pregnancy complications. Despite the enormous effort, prospective
studies are eagerly needed to corroborate our findings.